Screening for osteoporosis: a survey of older psychiatric inpatients at a tertiary referral centre

Background: Osteoporosis causes much morbidity and mortality among elderly people. Older inpatients with severe mental illness may be at particular risk of osteoporosis because of factors including immobility, vitamin D deficiency and psychotropic medication. Method: We screened predominantly older inpatients with severe mental illness for osteoporosis using a peripheral DEXA scanner. Associations were examined between patient variables and osteoporosis as detected by DEXA scan, Z-scores and history of fragility fractures. Patients were followed up to see how many subsequently received drug treatment for osteoporosis. Patient acceptability of the scanning technique was also assessed. Results: It was possible to scan 72/89 (81%) of patients. Mean T-score was -2.79 (SD 1.50) and mean Z-score -0.76 (SD 1.34). Forty-two (58%) patients had osteoporosis and 23 (32%) osteopenia. Twelve (17%) patients with a history of fragility fractures had osteoporosis on DEXA scan. A scan suggestive of osteoporosis and a history of fragility fractures were both associated with age of 75 years and over and thoracic kyphosis. Low Z-scores were associated with longer hospital stay and osteoporosis-predisposing drugs. Patient acceptability of scanning was high. At follow-up, only 7/16 (44%) patients were suitable for central scanning and 9/40 (23%) for bisphosphonates. Conclusion: Older institutional patients with severe mental illness are likely to be at high risk of developing osteoporosis. Peripheral DEXA scanning is acceptable to these patients and identifies those at high risk of fractures. Some behaviorally disturbed patients are not suitable for central scans or for some osteoporosis drug treatments.